News Mashup for July 2023
Will CalAIM’s Latest Reform Cut Behavioral Health Services?
California is in the midst of rolling out CalAIM, a multi-year Medi-Cal reform effort intended to optimize the state’s health insurance program for low-income residents. The repercussions of latest CalAIM reform measures, which went into effect on July 1, were reviewed by Kristen Hwang, an investigative reporter for CalMatters.
As of July 1, the DHCS changed the payment model for behavioral health providers so that those with advanced degrees are more highly compensated than peer support specialists—providers whose knowledge base is lived experience. In addition, reimbursements by the state for provider pay are now determined on a county-by-county basis, as calculated by local competitive rates. In a written statement to CalMatters, the DHCS said that the measures will “better enable counties and providers to deliver value-based care that improves quality of life for Medi-Cal members.”
Many of the providers that were interviewed for the CalMatters article are skeptical of DHCS’s “improvements.” Debbie Manners, the President and CEO of Sycamores, said the reform is “disheartening” because it discounts the value of lived experience. Manners emphasized that “many times it is the person with lived experience that keeps the family engaged.” Aldea Children and Family Services CEO, Kerry Ahearn, pointed out that “The new rates pay roughly half as much for a psychiatric nurse practitioner than for a psychiatrist, where previously payment would have been equal based on treatment provided. That results in providers getting less money for offering the same service as before.” Ken Dunlop, the president and CEO of Stars Behavioral Health Group told CalMatters that he “expects counties with higher rates to begin siphoning workers away from their neighbors.”
Citing data collected by the California Health Care Foundation, Hwang illustrated the potential siphoning effect with the example: “providers in Alameda County will be reimbursed more than $380 per hour for a mental health rehab specialist while providers in Shasta County will be reimbursed just below $35 per hour.”
In April of this year, the California Health Care Foundation engaged a group of experts to evaluate the impact such measures have had in states where similar strategies have been adopted. Their survey found “little empirical evidence” for improved outcomes for adult or children with substance use disorder or serious mental health problems.
In related news, the California Health Care Foundation released an Issue Brief this month explaining the history, impacts, and potential future of SAMHSA’s Certified Community Behavioral Health Clinics (CCBHC). As of March 2023, 19 California CCBHC have received one- to four-year grants from SAMSHA to implement or improve community-based mental health and substance use disorder services.
Click on the links below to learn more.
Kristen Hwang. July 6, 2023. Why mental health providers say Medi-Cal’s latest reform may force them to cut services. CalMatters. Retrieved July 28, 2023 from https://calmatters.org/health/2023/07/medi-cal-mental-health-2/.
Joshua Breslau, Marcela Horvitz-Lennon, Jonah Kushner, Nicole Eberhart, Mallika Bhandarkar, and Jonathan Levin. April 2023. CalAIM and Specialty Behavioral Health Care Lessons from Other States on Value-Based Payment. California Health Care Foundation. Retrieved August 3, 2023 from https://www.chcf.org/wp-content/uploads/2023/04/CalAIMSpecialty-Behavioral-HealthCareLessonsOtherStatesValueBasedPayment.pdf.
Robin Haller. July 21, 2023. Certified Community Behavioral Health Clinics in California explained. California Health Care Foundation. Retrieved July 31, 2023 from https://www.chcf.org/wp-content/uploads/2023/07/CertifiedCommunityBHClinicsCalExplained.pdf .
Debt-Free College for Foster Youth
The 2023-2024 California State Budget Bill, signed in stages by Governor Gavin Newsom in June and July, includes $25 M ongoing, annual funding for the new Fostering Futures program that enables foster youth to attend an in-state college for free when enrolled in a CCC, CSU, or UC institution. Fostering Futures, administered under the Middle-Class Scholarship Program, provides funding for any unmet monetary needs— including costs for housing, books, tuition, and food—after other financial aid is applied. The Fostering Futures bill was introduced to the legislature by Senator Angelique V. Ashby, 8th Senate District and Senate Majority Leader Mike McGuire, 2nd Senate District and sponsored by the John Burton Advocates for Youth. After the Governor signed the bill into law, Senator Ashby’s released a statement saying that “Far too many foster youth want to go to college, and are unable to afford it...64% of foster youth graduate high school, and only 4% of former foster youth obtain a 4-year college degree, though about 96% say they want to do so.”
Click on the links below to learn more about the Fostering Futures program and other foster youth news.
Mikhail Zinshteyn. July 6, 2023. California wants more college students to graduate debt-free. How’s the Middle Class Scholarship going so far? CalMatters. Retrieved July 31, 2023 from https://calmatters.org/education/higher-education/2023/07/middle-class-scholarship-california/.
Office of Senator Angelique V. Ashby. July 10, 2023. Senator Ashby secures $25 million in ongoing annual funding to make debt-free college a reality for California's foster youth. Retrieved July 31, 2023 from https://sd08.senate.ca.gov/news/senator-ashby-secures-25-million-ongoing-annual-funding-make-debt-free-college-reality.
Betty Márquez Rosales. July 11, 2023. Federal financial aid for foster youth: Quick Guide. EdSource Retrieved July 28, 2023 from https://edsource.org/2023/quick-guide-federal-financial-aid-for-foster-youth/693575.
David Kelly and Jerry Miller. July 11, 2023. The need to prioritize relational health. The Imprint. Retrieved July 28, 2023 from https://imprintnews.org/opinion/the-need-to-prioritize-relational-health/242912.
County Executive’s Office. July 11, 2023. A lift for life after foster care: County of San Mateo, California. Retrieved July 28, 2023 from https://www.smcgov.org/ceo/news/lift-life-after-foster-care.
Devika Ramcharan. July 5, 2023. What foster care agencies can do after we age out. The Imprint. Retrieved July 31, 2023 from https://imprintnews.org/youth-voice/what-foster-care-agencies-can-do-after-we-age-out/242510.
Scott Simon. July 15, 2023. There's a nationwide shortage of foster care families. NPR. Retrieved July 30, 2023 from https://www.npr.org/2023/07/15/1187929875/theres-a-nationwide-shortage-of-foster-care-families.
Sade Bess. July 18, 2023. Unfinished business: The ongoing issues of the foster care system. The Imprint. Retrieved July 30, 2023 from https://imprintnews.org/youth-voice/unfinished-business-the-ongoing-issues-of-the-foster-care-system/243045.
Oumou Fofana. July 21, 2023. New state legislation allows foster youth in California to attend college for free. yahoo! Entertainment. Retrieved July 31, 2023 from https://www.yahoo.com/entertainment/state-legislation-allows-foster-youth-100824325.html.
Jeanne Kuang. July 22, 2023. California counties siphon Social Security benefits from some foster kids. CalMatters. Retrieved July 31, 2023 from https://calmatters.org/california-divide/2022/07/foster-care-youth-california/.
One Year Anniversary of 988
This month marks the one-year anniversary of 988, the mental health hotline offering individuals experiencing a mental health crisis a quick connection to a trained professional. At a July 18, 2022 press briefing celebrating the activation of the hotline, Secretary of the U.S. Department of Health and Human Services, Xavier Becerra, promised that "988 won't be a busy signal, and 988 won't put you on hold. You will get help."
For the most part, the Secretary’s 2022 promise rings true. This month, the Kaiser Family Foundation (KFF) reported on national 988 implementation and usage. From July 2022 to May 2023 (most recent data available), the 988 hotline received almost 5 million calls (by landline, cellphone, text, or chat). National answer rates increased over the period reaching 93% in May 2023 and hold times decreased from about 2 minutes to about 30 seconds. The California 988 hotline received over 280,000 calls over the period. The latest California statistics reported by KFF show that in April and May of this year 58,493 calls were received with an answer rate of 90%.
The federal government provides 988’s launch and implementation funds, but ongoing cost are the responsibility of state and local governments. California is one of 24 states that have passed sustaining funding.
Click on the links below to learn more.
Heather Saunders. July 14, 2023. Taking a look at 988 Suicide & Crisis Lifeline implementation one year after launch. Kaiser Family Foundation. Retrieved July 28, 2023 from https://www.kff.org/other/issue-brief/taking-a-look-at-988-suicide-crisis-lifeline-implementation-one-year-after-launch/.
Anabel Sosa. July 19, 2023. ‘A lifesaving tool’: California’s new mental health crisis line sees a surge in calls. CalMatters. Retrieved July 30, 2023 from https://calmatters.org/health/mental-health/2023/07/988-hotline-california-mental-health.
Em Espey. July 21, 2023. Growing number of MoCo youth reach out to 988 helpline via text, chat. MoCo 360. Retrieved July 31, 2023 from https://moco360.media/2023/07/21/growing-number-of-moco-youth-reach-out-to-988-helpline-via-text-chat/.
Colleen DeGuzman. July 26, 2023. A Year With 988: What worked? What challenges lie ahead?. Kaiser Family Foundation. Retrieved July 31, 2023 from https://kffhealthnews.org/news/article/a-year-with-988-what-worked-what-challenges-lie-ahead/.
Biden Proposes Strengthening of Mental Health Parity
The 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law requiring insurers to cover treatment for mental health and substance use disorders in a manner no more restrictive than treatment for illnesses of the body. As MindSite News reports this month “the reality has been far messier as Americans seeking treatment for mental illness and substance abuse have continued to face an array of obstacles put up by their insurance plans.” [See also YMA News Mashups Reversal of Landmark Mental Health Parity Ruling and Update On Wit v. United Behavioral Health Mental Health Parity Ruling.]
This month, President Biden proposed a new rule to strengthened MHPAEA by requiring private insurers and Medicaid managed care organizations to identify and report gaps in care and close existing loopholes that let non-federal governmental health plans to opt out. Specifically, the “proposed rule would make clear that health plans need to evaluate the outcomes of their coverage rules to make sure people have equivalent access between their mental health and medical benefits.”
Click on the links below to learn more.
The White House. July 25, 2026. FACT SHEET: Biden-Harris administration takes action to make it easier to access in-network mental health care. Retrieved July 31, 2023 from https://www.whitehouse.gov/briefing-room/statements-releases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network-mental-health-care/.
Members of the CEO Alliance for Mental Health. July 25, 2023. Statement from the CEO Alliance on Biden administration’s push to improve parity. CEO Alliance for Mental Health. Retrieved July 31, 2023 from https://ceoallianceformentalhealth.org/statement-from-the-ceo-alliance-on-biden-administrations-push-to-improve-parity.
Lev Facher. July 25, 2023. White House unveils plan to make insurers cover mental health care. STAT. Retrieved July 31, 2023 from https://www.statnews.com/2023/07/25/mental-health-addiction-insurance-biden/.
Celeste Hamilton Dennis. July 26, 2023. Biden announces new rules to put teeth into mental-health parity legislation. MindSite News. Retrieved July 31, 2023 from https://mindsitenews.org/2023/07/26/biden-announces-new-rules-to-put-teeth-into-mental-health-parity-legislation/.
More Stories in July: For years, California failed its most vulnerable kids: Now it could make things even worse San Francisco Chronicle — 07.01.2023; A governor’s playbook for improving youth mental health should catch on The Washington Post — 07.04.2023; Hope and uncertainty linger as California turns the page on state-run youth prisons AP News — 07.05.2023; After deinstitutionalization, California has tragically come full circle on mental illness treatment CalMatters — 07.12.2023; Mental Health Services Act: Proposed restructuring of the MHSA funding categories and impacts on county spending Legislative Analyst’s Office — 07.13.2023; More children missing developmental milestones: Survey MedScape — 07.13.2023; Today’s racial, social tensions prompt a revival of yesteryear’s ‘freedom schools' Youth Today — 07.17.2023; Child and teen firearm mortality in the U.S. and peer countries Kaiser Family Foundation — 07.18.2023; After I got shot, my school did nothing to save me from failure: I’m fixing that The 74 — 07.19.2023; Ed Dept updates guidance on special ed noncompliance K-12 DIVE — 07.24.2023; Black students find allies in quest for better mental health: each other Chalkbeat — 07.27.2023; Can states' bans on transgender care hold up in court? We break down the arguments NPR — 07.28.2023; New bill would require states to distinguish poverty from child neglect The Imprint — 07.28.2023; Survey: Social emotional development a top priority for parents Public News Service — 07.31.2023; Training today’s youth to become tomorrow's mental health care providers EdSurge — 07.31.2023; L.A. County gave up on a mental health program — and is handing back millions in grants Los Angeles Times — 07.31.2023.
